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Peer-reviewedCC BY 4.0Frontiers in Neurology

Clinical characteristics, disability outcomes, and disease-modifying therapy patterns in late-onset multiple sclerosis: a single-center retrospective cohort study

  • Ruslan Alomar1
  • Elīna Polunosika2,3
  • Guntis Karelis2,3
  • Daina Pastare2,3
  1. 1Faculty of Medicine, Rīga Stradin´š University
  2. 2Neurology and Neurosurgery Department, Riga East University Hospital
  3. 3Neurology and Neurosurgery Department, Rīga Stradin´š University
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Abstract

Background: Late-onset multiple sclerosis (LOMS), defined here as symptom onset at age 50 years or later, is associated with diagnostic complexity, a higher prevalence of progressive phenotypes, greater disability, and challenging disease-modifying therapy (DMT) decisions. We characterized clinical manifestations, magnetic resonance imaging (MRI) lesion distribution, disability outcomes, and DMT patterns in a Latvian tertiary-care cohort.

Methods: We retrospectively reviewed medical records from Riga East University Hospital. Of 518 patients in the source multiple sclerosis dataset, 59 met the LOMS definition; after exclusion of two patients with clinically isolated syndrome and one with an unspecified phenotype, 56 patients with relapsing-remitting, primary progressive, or secondary progressive multiple sclerosis were analyzed. Clinical symptoms, MRI lesion localization, baseline and five-year Expanded Disability Status Scale (EDSS) scores, EDSS change, and initial and current DMT patterns were assessed using nonparametric and exact tests.

Results: The cohort included 38 women and 18 men; 38 patients had relapsing-remitting multiple sclerosis and 18 had progressive multiple sclerosis. Progressive phenotypes were associated with more frequent pyramidal/motor symptoms (100.0% vs. 76.3%; p = 0.045) and bowel/bladder dysfunction (72.2% vs. 42.1%; p = 0.035). Baseline EDSS was higher in progressive disease (median 3.75 vs. 2.00; p < 0.001), as was five-year EDSS among the 39 patients with available follow-up (median 6.00 vs. 3.00; p < 0.001), whereas EDSS change did not differ significantly ( p = 0.377). Anti-CD20 and other high-efficacy DMTs were used more frequently in progressive phenotypes and in patients with greater observed disability.

Conclusion: Progressive LOMS phenotypes were associated with greater motor and sphincter symptom burden and higher disability, but the absence of a difference in unadjusted EDSS change should not be interpreted as equivalent disability progression. Treatment associations primarily describe real-world selection and are subject to confounding by indication.

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Cite

BibTeXRIS
BibTeX
@article{alomar2026clinical,
  title = {{Clinical characteristics, disability outcomes, and disease-modifying therapy patterns in late-onset multiple sclerosis: a single-center retrospective cohort study}},
  author = {Ruslan Alomar and Elīna Polunosika and Guntis Karelis and Daina Pastare},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1966162},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1966162/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Clinical characteristics, disability outcomes, and disease-modifying therapy patterns in late-onset multiple sclerosis: a single-center retrospective cohort study
AU  - Ruslan Alomar
AU  - Elīna Polunosika
AU  - Guntis Karelis
AU  - Daina Pastare
PY  - 2026
DA  - 2026/10/21
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1966162
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1966162/full
AB  - Background: Late-onset multiple sclerosis (LOMS), defined here as symptom onset at age 50 years or later, is associated with diagnostic complexity, a higher prevalence of progressive phenotypes, greater disability, and challenging disease-modifying therapy (DMT) decisions. We characterized clinical manifestations, magnetic resonance imaging (MRI) lesion distribution, disability outcomes, and DMT patterns in a Latvian tertiary-care cohort.  Methods: We retrospectively reviewed medical records from Riga East University Hospital. Of 518 patients in the source multiple sclerosis dataset, 59 met the LOMS definition; after exclusion of two patients with clinically isolated syndrome and one with an unspecified phenotype, 56 patients with relapsing-remitting, primary progressive, or secondary progressive multiple sclerosis were analyzed. Clinical symptoms, MRI lesion localization, baseline and five-year Expanded Disability Status Scale (EDSS) scores, EDSS change, and initial and current DMT patterns were assessed using nonparametric and exact tests.  Results: The cohort included 38 women and 18 men; 38 patients had relapsing-remitting multiple sclerosis and 18 had progressive multiple sclerosis. Progressive phenotypes were associated with more frequent pyramidal/motor symptoms (100.0% vs. 76.3%; p = 0.045) and bowel/bladder dysfunction (72.2% vs. 42.1%; p = 0.035). Baseline EDSS was higher in progressive disease (median 3.75 vs. 2.00; p < 0.001), as was five-year EDSS among the 39 patients with available follow-up (median 6.00 vs. 3.00; p < 0.001), whereas EDSS change did not differ significantly ( p = 0.377). Anti-CD20 and other high-efficacy DMTs were used more frequently in progressive phenotypes and in patients with greater observed disability.  Conclusion: Progressive LOMS phenotypes were associated with greater motor and sphincter symptom burden and higher disability, but the absence of a difference in unadjusted EDSS change should not be interpreted as equivalent disability progression. Treatment associations primarily describe real-world selection and are subject to confounding by indication.
SN  - 1664-2295
ER  -